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Coronavirus in Ohio: What is contact tracing? How we stamp out infectious disease

Lifting the coronavirus shutdown in the Cincinnati region, states and the nation largely rests on counties and cities performing an unsung but vital task of public health, contact tracing. Here are six questions about that tool.

How is contact tracing done?

One job of public health is to control infectious disease in a population. Positive test results for diseases such as tuberculosis, syphilis, measles, HIV or chickenpox are reported to a local health department.

Contact tracing, an old method that helped eradicate smallpox, is used every day. The contact trace begins when an epidemiologist or a nurse alerts the person with a positive result – the “index patient” – and learns about all close recent contacts. The tracer then reaches those contacts to warn about possible infection and urge precautions.

Matt Clayton, Springdale’s health commissioner, said contact tracing is an essential disease investigation device. But contact tracing also spreads health information to people who are at risk and gives them guidance on next steps.

For coronavirus, contact tracers ask patients to name all close contacts going back to two days before symptoms of infection. Tracers then reach out to the close contacts and counsel a 14-day quarantine to get past the incubation period of the virus. Tracers monitor those contacts daily for signs of illness.

All contacts are interviewed by phone.

[Please support The Enquirer’s coverage about the local outbreak of the novel coronavirus and COVID-19 with a subscription.]

How does this action stop infection?

Contact tracing lets public health officials figure out paths of infection. If they can keep possibly infected people from infecting others through community spread, the virus dies.

“Contact tracing is one of the fundamentals of public health,” said Mike Samet, spokesman for Hamilton County Public Health.

What is the state doing?

Ohio Gov. Mike DeWine said last contact tracing is critical for the economy as the state peels away restrictions imposed in March to stop the infection. But the state doesn’t have enough workers to do that assignment as cases of the coronavirus will remain high for months.

Maryse Amin, supervising epidemiologist for the Cincinnati Health Department, said the general rule is to have 10 contact tracers for every 100,000 people in the population.

The state is working with the Boston health nonprofit Partners in Health to build the existing force of contact tracers of about 700 workers in the state’s 113 county and city health departments to between 1,750 and 2,000 in the coming months.

On Monday April 27, Gov. Mike DeWine said Ohio would work to increase the number of people conducting contact tracing, a public-health tool that tracks the course of infection with the aim of stopping it.(Photo: Provided by the office of Gov. Mike DeWine)

The workers would not only track coronavirus but also help local health departments with contact tracing of more common infectious illnesses. Summer, for example, brings West Nile virus and other mosquito-borne infections.

Can you volunteer to contact trace?

Not off the street. State and local officials say contact tracers require special training on getting information from index patients.

Is contact tracing a privacy violation?

Ohio, Kentucky and other states give public health agencies wide latitude in managing a health crisis. Information collected in contact tracing is a private health record and kept confidential. People reached in contact tracing are not even told the name of the index patient.

Tara Jimison, epidemiologist for Clermont County Public Health and a registered nurse, said that because contact tracing is nothing new in public health, “The public understands the impact of identifying their close contacts, and they’re willing to participate in stopping that spread.”

Apple and Google have been working on mobile phone apps that could alert a user to close contact with someone who had a positive coronavirus test. Some privacy experts have expressed concerns about the security of that information.

Who’s doing what?

The Enquirer reached out to 14 jurisdictions in the Cincinnati region to ask about contact tracing. The list will be updated when public health departments respond.

Adams County: No response yet.

Brown County: Pamela Williams, nursing director for the Brown County Health Department, said two fulltime nurses and one part-time nurse do the contact tracing in the county of 45,000 people and sometimes in adjacent counties. Although “there have been thousands of calls regarding COVID-19,” the county so far has 11 confirmed cases, five probable cases and one death.

“We are used to having to do this, being that we live in a small rural county connected to other larger counties,” Williams said. “If I had a guess a number to date, we have completed 100s of contact tracings.”

As with every communicable disease, “Some people are reluctant to give us the information we need,” Williams said. “Most, however, are very forthcoming.”

Butler County: The Nursing and Epidemiology Department of the Butler County General Health District conducts contact tracing, said spokeswoman Erin Smiley.

“When an individual receives a positive test result, our staff works with the individual to develop a timeline of potential community exposures,” she said. “People and places are identified based on the movement of the individual that received a positive result.”

City of Cincinnati: Amin said 18 professionals have contact-traced 120 patients who have recovered from COVID-19, the illness that can occur after infection. They are now are monitoring about 300 people.

Maryse Amin, supervising epidemiologist for the Cincinnati Health Department, oversees the agency's contact tracing for infectious diseases in the city. The tool, following on viral testing, can help public health control infection, as with the new coronavirus.(Photo: Provided)

The professionals include department epidemiologists and nurses who usually work in the department’s school-based health centers.

Amin is concerned that the incidence of infection has been underreported due to the lack of testing. When more tests produce more positive results, the contact tracers will have more people to call.

Clermont County: Spokesman Keith Robinson said the county health department has 10 people working on COVID-19 contact tracing, six staff nurses who are trained to do contact tracing and four staff members recently trained.

Clinton County: No response yet.

City of Hamilton: No response yet.

Hamilton County: The county health department has trained 20 workers as contact tracers. Interim Health Commissioner Greg Kesterman said each confirmed COVID-19 case has on average 20 close contacts. Kesterman said more county workers could be trained for contact tracing as the state reopens its economy.

Highland County: Health Commissioner Jaren Warner said his three nurses now on staff have done all the contact tracing so far. About 260 county residents have been in isolation or quarantine.

The issue for Appalachian Ohio is while fewer people are sick, Warner said, “We continue to face resource shortages, in part because supplies tend to go towards the big orders and big spenders.”

“I also am concerned about how our local COVID-19 cases will fare compared to other parts of the state,” Warner said. “We tend to have high rates of diabetes, obesity, smoking and other underlying health factors that lead to poorer health outcomes. Combine that with limited access to health care in general, and it helps to drive home how important it will be for our local public health system to effectively control the spread of COVID-19.”

Middletown: No response yet.

Northern Kentucky: Public health spokeswoman Laura Brinson said the agency’s epidemiology manager, Zach Raney, oversees contact tracing, and usually, his staff of five typically does the job. Another 20 workers from other sections of the health department have been added to contact tracing. So far, Brinson said, they have done 410 contact tracings in the four-county health district.

Zach Raney, epidemiology manager for Northern Kentucky Public Health, makes a phone call as part of a contact trace -- where authorities track everyone in contact with someone suffering an infectious disease.(Photo: Provided)

Springdale: Commissioner Clayton said that normally, his department has one person doing contact tracing and, “We have exceeded that capacity.” Other health department workers are now also doing contact tracing, and furloughed staffers have been trained to do interviews.